A headache is secondary when it is caused by another condition. The term is used to distinguish this type of headache from the primary headache disorders like migraine, tension-type headache, or cluster headache. Many medical conditions can cause headache, but there are usually clues in the medical history or examination to suggest secondary headache.

Headache can be caused by general medical conditions such as severe hypertension, or by conditions that affect the brain and its coverings. Infections of the head and neck, including pharyngitis, sinusitis, and meningitis have headache as a symptom. Head trauma, even if it is mild, can often lead to headache. Anything that takes up space inside the head can cause headache, including tumor, subdural hematoma, and hydrocephalus. Other blood vessel problems, like subarachnoid hemorrhage, which can result from rupture of an aneurysm can lead to severe headache.

The key to distinguishing secondary headaches from primary headache lies in the features of the headache, other symptoms occurring at the same time, and the physical examination. Your doctor often looks for warning signs that would point to a secondary headache over a primary headache.

These include:

    First or worst headache of your life.

  • Abrupt onset of headache without any warning or build-up.
  • Fundamental change in the pattern of recurrent headaches.
  • Headache beginning at unusual ages.
  • ≤5 years old.
  • ≥50 years old.
  • The presence of cancer, HIV, pregnancy.
  • Abnormal physical exam.
  • Headache onset:
  • with seizure or syncope.
  • with exertion, sex or Valsalva (squeezing).

There are also features that your doctor will look for that will be reassuring that a primary headache disorder exists:

    Stable pattern of headache over many months or years.

  • Long-standing history.
  • Family history of similar headaches.
  • Normal physical exam.
  • Headaches consistently triggered by:
  • Hormonal cycle.
  • Specific foods.
  • Specific sensory input
  • Weather changes.

Talk to your doctor if you have concerns that your headache may be due to some other medical condition. Being confident that there is no secondary cause for headache is an important first step to developing an effective treatment plan for headache.

This article is a legacy contribution from the American Headache Society Committee for Headache Education (ACHE) and the Fred Sheftell, MD Education Center.